Tuesday, January 3, 2012


For years, I thought that Medicare and Medicaid were two different terms for the same program.  Like ESL and ELD, or Iran and Iraq.  (I jest.  But I do, embarrassingly, always confuse the two.)  Then my parents got old and went on Medicare, and I still didn't know the difference.  Then, in a chance conversation with my aunt about how we couldn't afford the kind of help my dad needed, she explained a bit about Medicaid.  Bless you, Aunt Margaret.  Four decades of extremely distant aunthood compensated for in an offhand comment that looks like it will save our butts.

Here's the scoop.  Medicare is a health insurance program for people over 65 or disabled.  Basically, if you qualify for social security disbursements, you qualify for Medicare.  It's not just one government program, but a group of health insurance plans approved, and, I believe, subsidised by the Medicare office.  Since my dad was self employed and my mom was, um, also self employed, they had crap insurance for much of their middle age and beyond.  As their dependent, in college I twice visited the emergency room for stuff a family doctor could have handled, just because our insurance was so lame.  In their 60s and 70s, Mom and Dad had a lot more medical issues than your average college student, so medical bills were eating up a huge amount of their income.  As a result, they were actually kind of excited to go on Medicare.  A few years ago, they got into a program that didn't even require any premiums at all, which was definitely more in line with their budget.  I don't know the details, but I think that their limited income is why they qualified for that particular arm of the program. 

Medicaid is different.  Because aid and care are different, see?  Medicaid provides financial support not just for health insurance, but for living expenses.  In order to qualify, you have to be seriously broke.  Last spring my dad was living in his own home (although with a reverse mortgage--more on that later, in the meantime, DON'T LET YOUR PARENTS GET ONE), owned a car, had a few thousand in the bank from my mom's life insurance, plus his whopping social security check and over $300 a month in pension funds heading his way.  We thought he was basically broke, but when we tried to get him Medicaid, he didn't qualify.  He was livid.  I pointed out that it meant there were people worse off than him. Somehow this didn't mollify him.

He had too much money and assets to qualify.  As long as he could stay in his house, his measley income worked out.  But when he needed more care, any option we looked at, from home help to assisted living to an adult foster care home, cost more than his income, and his savings weren't going to last long.  We were all entering a state of terror.  His main concern was that he'd end up on the streets.  This didn't seem terribly realistic to his four daughters--I mean, come on, this ain't King Lear.  But we were all wondering which of us was going to have to move into a house with ground floor bedrooms and quit her job to take care of him.  At which point, it might have become rather Shakespearean after all.  That's when Margaret said, "You need to go into a Medicaid spend-down.  They'll let him keep $2,000."  We had very little idea what she meant, but we started looking into it. 

They're serious about the $2,000.  Now that he's in adult foster care, where the rent is double his monthly income, we knew we needed to get him signed up.  But when I talked to someone at DHS and she heard he still had $5,000 in the bank, she told me to call back the next month.  So we payed the $3,300 for rent and tried again a month later.  I answered questions, and tomorrow is our intake interview.  Wish us luck.  If he qualifies, Medicaid takes over paying the rent.  They have an option to pay for food as well, if that were needed separately. 

Next time I'll go over the questions you need to be able to answer for the screening and the paperwork you need to gather for the intake interview.  Since your odds of actually getting a human being on the line at DHS are about equal to the odds of  hitting all green lights on your way to work when you're running late, it helps to know up front what they're going to ask, so you don't waste an actual conversation on just finding out what you need to know the next time you're lucky enough to get someone to pick up the phone.  And hopefully, I will also tell you that he passed the interview stage.  Did you wish us luck back in the previous paragraph?  If not, take a minute to do so now.  Thanks.


  1. GOOD LUCK GOOD LUCK GOOD LUCK TOMORROW. Thanks for sharing this.. - Liz

  2. It is amazing how complicated it all is- how does ANYONE manuver through this system? Good luck and let us know how the interview goes!